Healthcare Provider Details

I. General information

NPI: 1023726866
Provider Name (Legal Business Name): LIFELINE PROFESSIONAL COUNSELING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7565 E EAGLE CREST DR STE 101
MESA AZ
85207-1041
US

IV. Provider business mailing address

335 N ALMA SCHOOL RD STE E
CHANDLER AZ
85224-4363
US

V. Phone/Fax

Practice location:
  • Phone: 480-641-1165
  • Fax: 480-641-9026
Mailing address:
  • Phone: 817-965-5908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ROXANNE DALPOS
Title or Position: PRESIDENT
Credential: PH.D
Phone: 480-203-8414